Short-term risk factors for a second hip fracture in a UK population

Impact of diabetes on the risk of subsequent fractures in 92,600 patients with an incident hip fracture: A Danish nationwide cohort study 2004-2018

PURPOSE

We investigated the incidence rates of a subsequent hip fracture (HF) and other subsequent fractures than HF after first incident HF, comparing patients with and without diabetes.

METHODS

Using Danish medical databases, we identified 92,600 incident HF patients in the period 2004-2018. Diabetes exposure was examined overall, by type of diabetes (T2D and T1D), and by presence of diabetes complications. We estimated cumulative incidence of subsequent HFs and fractures other than HF within two years of the incident HF. Using Cox regression, adjusted hazard ratios (aHRs) with 95 % confidence interval (CI) were calculated.

RESULTS

Among incident HF patients, 11,469 (12 %) had diabetes, of whom 10,253 (89 %) had T2D and 1216 (11 %) had T1D. The 2-year incidence rates for a new subsequent HF were 4.8 % (95 % CI: 4.6-4.9) for patients without diabetes (reference group), 4.1 % (95 % CI: 3.8-4.6) for T2D, and 4.3 % (95 % CI: 3.3-5.6) for T1D. Corresponding aHRs were 1.01 (95 % CI 0.90-1.14) for T2D and 1.17 (95 % CI 0.87-1.58) for T1D. There was effect modification by sex, as women with T1D had an aHR of 1.52 (95 % CI: 1.09-2.11) for subsequent HF, and by specific diabetes complications (for example, patients with T2D and prior hypoglycemia had an aHR of 1.75 (95 % CI: 1.24-2.42) for subsequent HF, while patients with T1D and neuropathy had an aHR of 1.73 (95 %: 1.09-2.75), when compared with patients without diabetes). For fractures other than HF, the 2-year incidence rates were 7.3 % (95 % CI: 7.2-7.5) for patients without diabetes, 6.6 % (95 % CI: 6.1-7.1) for T2D, and 8.5 % (95 % CI: 7.0-10.1) for T1D, with corresponding aHRs of 1.01 (95 % CI 0.92-1.11) for T2D and 1.43 (95 % CI: 1.16-1.78) for T1D. T2D was only a risk factor for other subsequent fractures among HF patients of high age (age 86-89 years: aHR 1.22 (95 % CI 0.99-1.55), age 90+ years: aHR 1.37 (95 % CI 1.08-1.74)), whereas T1D was robustly associated with increased risk of fractures other than HF in all subgroups.

CONCLUSION

Among HF patients, we found no strong overall association of T2D or T1D with increased risk of subsequent HF, but diabetes patients with prior hypoglycemic events or neuropathy were at increased risk. In contrast, patients with T1D had a clearly increased risk of subsequent fractures other than HF.

Risk factors for subsequent fractures in hip fracture patients: a nested case-control study

BACKGROUND

The risk factors for subsequent fractures following an initial hip fracture are not entirely understood. This study examined the clinical characteristics of hip fracture patients to identify potential risk factors associated with a higher risk of experiencing subsequent fractures.

METHODS

We conducted a nested case-control study using data from the Chinese PLA General Hospital Hip Fracture Cohort between January 2008 and March 2022. The cases were individuals who experienced subsequent fractures following an initial hip fracture. Each case was matched with up to 2 controls who did not develop subsequent fractures. Important clinical factors were compared across groups, including traditional fracture risk factors and potential risk factors (e.g., comorbidities, falls risk, physical impairment, calcium or vitamin D use, and anti-osteoporosis medications). Conditional logistic regression analyses were used to evaluate the impact of these clinical features as potential risk factors for subsequent fractures.

RESULTS

A total of 96 individuals who suffered from subsequent fractures were matched with 176 controls. The median time between the initial hip fracture and the subsequent fracture was 2.1 years. The overall proportion of patients receiving anti-osteoporosis treatment after initial hip fracture was 25.7%. In the multivariable regression analysis, living in a care facility (OR = 3.78, 95%CI: 1.53-9.34), longer hospital stays (OR = 1.05, 95%CI: 1.00-1.11), and falls after discharge (OR = 7.58, 95%CI: 3.37-17.04) were associated with higher odds of subsequent fractures.

CONCLUSIONS

This study showed that living in a care facility, longer hospital stays, and falls after discharge may be independent risk factors for repeat fractures following an initial hip fracture. These findings could be used to identify and manage patients at high risk of subsequent fractures.

The Characteristics and Outcomes of Contralateral Non-Concurrent Hip Fractures: A Retrospective Study in Geriatric Patients

Background and Objectives: This study aimed to determine the relationship between non-simultaneous contralateral hip fractures, urban and rural differences, fracture localization, time between fractures, physiotherapy applications, comorbidity, and the second fracture outcomes. Materials and Methods: We retrospectively analyzed 107 patients aged 65 and older with proximal femur fractures (PFFs) who underwent surgery at Düzce University Medical Faculty between January 2010 and December 2022. High-energy fractures, pathological fractures, and patients with a history of old fractures were excluded. Results: The study included 66 females (61.7%) and 41 males (38.3%), with a mean age of 83.76 years. The mean interval between two fractures was 28.3 months. There was no statistical difference between the localization of the first and second fractures (p = 0.107). However, there was a significant difference in the first PFF localizations of patients living in rural areas (p = 0.023). Patients with heart failure, respiratory failure, osteoporosis, and cognitive impairment had shorter intervals between fractures (p < 0.001). Conclusions: This study shows that age, female gender, place of residence, comorbid diseases, and whether physical therapy is received after the first fracture are significant risk factors for a second hip fracture in patients over 65 years of age.

Patients' recovery of mobility and return to original residence after hip fracture are associated with multiple modifiable components of hospital service organisation: the REDUCE record-linkage cohort study in England and Wales

BACKGROUND

Hip fractures are devastating injuries causing disability, dependence, and institutionalisation, yet hospital care is highly variable. This study aimed to determine hospital organisational factors associated with recovery of mobility and change in patient residence after hip fracture.

METHODS

A cohort of patients aged 60 + years in England and Wales, who sustained a hip fracture from 2016 to 2019 was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality records were linked to 101 factors derived from 18 hospital-level organisational metrics. After adjustment for patient case-mix, multilevel models were used to identify organisational factors associated with patient residence at discharge, and mobility and residence at 120 days after hip fracture.

RESULTS

Across 172 hospitals, 165,350 patients survived to discharge, of whom 163,230 (99%) had post-hospital discharge destination recorded. 18,323 (11%) died within 120 days. Among 147,027 survivors, 58,344 (40%) across 143 hospitals had their residence recorded, and 56,959 (39%) across 140 hospitals had their mobility recorded, at 120 days. Nineteen organisational factors independently predicted residence on hospital discharge e.g., return to original residence was 31% (95% confidence interval, CI:17-43%) more likely if the anaesthetic lead for hip fracture had time allocated in their job plan, and 8-13% more likely if hip fracture service clinical governance meetings were attended by an orthopaedic surgeon, physiotherapist or anaesthetist. Seven organisational factors independently predicted residence at 120 days. Patients returning to their pre-fracture residence was 26% (95%CI:4-42%) more likely if hospitals had a dedicated hip fracture ward, and 20% (95%CI:8-30%) more likely if treatment plans were proactively discussed with patients and families on admission. Seventeen organisational factors predicted mobility at 120 days. More patients re-attained their pre-fracture mobility in hospitals where (i) care involved an orthogeriatrician (15% [95%CI:1-28%] improvement), (ii) general anaesthesia was usually accompanied by a nerve block (7% [95%CI:1-12%], and (iii) bedside haemoglobin testing was routine in theatre recovery (13% [95%CI:6-20%]).

CONCLUSIONS

Multiple, potentially modifiable, organisational factors are associated with patient outcomes up to 120 days after a hip fracture, these factors if causal should be targeted by service improvement initiatives to reduce variability, improve hospital hip fracture care, and maximise patient independence.

Association between pharmacotherapy and secondary hip fracture in a real-world setting: a nationwide database study

INTRODUCTION

This study aimed to assess the association between pharmacotherapy and secondary hip fracture incidence.

MATERIALS AND METHODS

The correlation between secondary hip fracture incidence and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

RESULTS

Data collected from female patients (n = 1,435,347) were analyzed. The 2-year secondary hip fracture incidence was 3.48% (n = 49,921). Secondary hip fracture was significantly more common in patients without medications (3.80%) than in those with medications (3.00%). Patients receiving selective estrogen receptor modulators (SERMs) had the lowest average age. The crude incidence of secondary hip fracture was the lowest in patients receiving SERMs (n = 2088 [2.52%]), followed by those taking bisphosphonates (n = 11,355 [2.88%]), denosumab (n = 1118 [2.90%]), no medications (n = 32,747 [3.80%]), and parathyroid hormone (PTH: n = 2163 [4.55%]), whereas the age-adjusted incidence was the lowest in patients administered denosumab (2.27%), followed by those taking bisphosphonates (2.47%), SERMs (2.55%), PTH (3.67%), and no medications (3.80%). The mean MPR was the highest in patients taking denosumab (64.9%), followed by those receiving bisphosphonates (58.7%), SERMs (58.2%), and PTH (40.6%) in the no hip fracture group.

CONCLUSION

Secondary hip fractures were less likely to occur with medication versus no medication. Differences in the crude incidence of secondary hip fracture based on medications usage might be attributed to background characteristics.

Bisphosphonates Prescription for Patients With Hip Fractures Based on Evaluation by a Dentist

Background The purpose of this study is to clarify the current status of the prescription of postoperative bisphosphonates for patients with hip fractures and to explore the factors that prevent the postoperative prescription of bisphosphonates. Methods Of 180 patients with hip fractures treated surgically at our hospital between August 2019 and April 2020, 149 patients (46 men and 103 women; mean age: 83.9 ± 9.0 years), excluding 31 patients already prescribed bisphosphonates or denosumab, were included in the study. All patients were treated based on our clinical pathway, and their risk of jaw osteonecrosis was evaluated prior to the initiation of bisphosphonates by a dentist in our hospital. We collected data from the medical records on osteoporosis treatment interventions at admission and discharge, the reasons why postoperative bisphosphonates could not be prescribed at discharge, the proportion of patients who had follow-ups at our hospital, and patients' osteoporosis treatment status. Results Eighteen (12.8%) and 95 (63.8%) patients were prescribed anti-osteoporosis drugs at admission and discharge, respectively. One hundred and twenty-one patients (86.8%) could not be prescribed postoperative bisphosphonates at discharge - 71 (58.7%) because of oral hygiene problems, 34 (28.1%) because they did not have regular dental consultations, seven (5.8%) because of renal dysfunction, eight (6.6%) because of poor cognitive and swallowing function, and one (0.8%) because of medication side effects. Forty-nine patients (32.9%) went to our hospital for follow-up and 11 were introduced to bisphosphonates or denosumab at follow-up. Conclusions The number of patients with hip fractures who were prescribed postoperative bisphosphonates was low in our study. The oral hygiene problems identified by dentists accounted for responsible for the low prescription rate of postoperative bisphosphonates. Therefore, coordination with dentists may be important to increase the postoperative bisphosphonate prescription.

Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study

Considerable uncertainty prevails regarding risk factors for recurrent fracture among older patients with hip fracture. We aimed to investigate the relationship between prefracture stroke history, baseline mobility, and the risk of recurrent hip fracture. This cohort study was based on the Danish Multidisciplinary Hip Fracture Registry, 2011-2018 (n = 48,230). We estimated cumulative incidence (competing risk of death) of recurrent hip fracture and major osteoporotic fractures within 1 and 2 years comparing patients with/without prefracture stroke history. Analyses were performed overall and stratified on baseline mobility status (good mobility: Cumulated Ambulation Score ≥ 5 versus poor mobility: Cumulated Ambulation Score < 5). Using Cox regression, adjusted cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were obtained. The 1-year cumulative incidence was 4.6% (95% CI: 3.9-5.4) among patients with stroke history and 4.3% (95% CI: 4.1-4.5) among patients without stroke history. For patients with good mobility, the cumulative incidence of recurrent hip fracture was 5.8% (95% CI: 4.3-7.5) versus 3.7% (95% CI: 3.4-4.0) for patients with versus without stroke history. Corresponding numbers for patients with poor mobility were 4.4% (95% CI: 3.6-5.5) and 5.0% (95% CI: 4.7-5.3). Stroke history was associated with an adjusted HR of 1.55 (95% CI: 1.15-2.10) for recurrent fracture among patients with good mobility. In contrast, no association was observed among patients with poor mobility (adjusted HR 0.88 [95% CI: 0.70-1.10]). The associations were attenuated after 2 years of follow-up and for major osteoporotic fractures. In conclusion, stroke history was associated with slightly higher risk of recurrent fracture among patients with first-time hip fracture in the overall analysis, although the CI included a null result. The association was modified by baseline mobility: Patients with stroke history and good mobility had a markedly higher risk, whereas patients with stroke and poor mobility did not. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly

BACKGROUND

Fragility fractures of the hip are known to be followed frequently by subsequent fragility fractures, including second hip fractures. Data on subsequent fractures are available for aggregated index femoral neck and intertrochanteric femoral fractures, grouped generically as hip fractures, but not specifically for femoral neck fractures. There is increasing recognition that a subsequent fracture often occurs early after a hip fracture in the elderly, creating an emphasis on the concept of "imminent fracture risk." Since 2000, there have been many reports on the care gap in interventions after a fragility fracture, with concern regarding the slow uptake of appropriate systemic treatments designed to prevent a subsequent fracture in high-risk patients.

METHODS

As planned a priori, we performed an analysis of subsequent fractures after an index femoral neck fracture in 2 prospective clinical trials involving 2,520 patients from 90 sites on 5 continents. We recorded the incidence and time of occurrence of all secondary fragility fractures as well as the reported use of bone-protective medication in all subjects.

RESULTS

In the 24 months following the index femoral neck fracture, 226 (9.0%) of 2,520 patients sustained at least 1 subsequent fragility fracture, including 113 hip fractures (4.5%). The median interval from the index fracture to a subsequent fracture was approximately 9.0 months. Only 25.2% (634) of the 2,520 patients reported using bone-protective medications at any time during follow-up. Female patients, those with nondisplaced index fractures, and those treated with arthroplasty, were more likely to have received protective medication.

CONCLUSIONS

Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in 2 large global cohorts. Interventions to prevent a subsequent fracture were instituted in only 1 of 4 patients, even though a focused directive was included in both study protocols.

LEVEL OF EVIDENCE

Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Montreal cognitive assessment (MoCA) is highly correlated with 1-year mortality in hip fracture patients

Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.

INTRODUCTION

Hip fractures rank amongst the top 10 causes of disability and current mortality of hip fractures is high. Objectives were to determine 1) prevalence of cognitive impairment, 2) whether Montreal Cognitive Assessment (MoCA) score was an independent risk factor associated with mortality, 3) MoCA cut-off that result in high risk of mortality.

METHODS

This was a cohort study between July 2019 to June 2020. Inclusion criteria were 1) hip fracture, 2) >  = 65 years old, and 3) low-energy trauma. Patients undergo assessment for cognitive impairment with MoCA. Prevalence was assessed, MoCA cut-off point, and accuracy of statistical model was evaluated. Logistic regression modelling was used to assess association between mortality and MoCA.

RESULTS

There were 260 patients recruited. Two hundred twenty-five patients had MoCA score < 22 signifying cognitive impairment, and 202 patients had MoCA score of < 19. 46 hip fracture patients died at 1-year follow-up. 45 of these patients had MoCA score < 19, and 1 patient had a MoCA > 22. Results showed statistical significance and good model effect (at least 0.8) with MoCA cut-off points between < 15 and < 19 (p < 0.05). After controlling confounding factors, statistical significance still existed in MoCA cut-off point at < 15 (odds ratio (95% CI) = 11.71 (1.14, 120.71); p = 0.04).

CONCLUSION

Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality in hip fracture patients. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality at 1-year after a hip fracture. AUC with MoCA score < 15 was 0.948. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.

Risk factors for a second nonsimultaneous hip fracture in a prospective cohort study

INTRODUCTION

The risk factors for a second nonsimultaneous hip fracture are unclear, and in general, it is empirically assumed that they are similar to those associated with the first hip fracture. We aimed to determine the incidence of a second hip fracture and define the characteristics of the patients sustaining the event in a prospective cohort study in a Spanish population.

MATERIALS AND METHODS

We conducted a multicentric, prospective cohort study in a representative sample of 45 hospitals from 15 autonomic regions in Spain. In total, the study included 994 patients. One hundred and one patients presented a nonsimultaneous contralateral hip fracture, constituting the intervention group. The remaining 893 patients presenting with a hip fracture formed the control group. The main outcome measures of this study were sociodemographic characteristics of the patient, comorbid conditions, and baseline and postfracture clinical outcomes (inpatient complications and acute mortality).

RESULTS

The key fracture risk factors were a history of fragility fractures, the need for assistance when walking outdoors and a history of falls. There were no associations between the groups in any of the common fragility risk factors, including rheumatoid arthritis, secondary osteoporosis, or steroid consumption. The results showed that patients suffering a nonsimultaneous hip fracture had an increased risk of mortality after discharge compared with the control group.

CONCLUSION

A nonsimultaneous second hip fracture leads to a near-significant increase in four-month mortality. In our study, this fracture was associated with a history of falls, prior fragility fractures, and the need for a walking aid.

Association of pharmacotherapy with the second hip fracture incidence in women: A retrospective analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan

AIM

Second hip fractures worsen the quality of life and are associated with increased mortality. We clarified the association between the pharmacotherapy and second hip fracture prevention.

METHODS

The relationship between the incidence of second hip fracture and the presence, type and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan during April 2012 to March 2019.

RESULTS

Data of 776 040 female patients were analyzed. The 2-year rate of second hip fractures was 3.31% (n = 25 684). Bisphosphonates (n = 148 138, 19.1%) were the most commonly used medications after primary hip fracture. Patients receiving selective estrogen receptor modulators (SERMs) had the lowest age, followed by those receiving bisphosphonates, denosumab and parathyroid hormone (PTH). The second hip fracture crude incidence was lowest in patients administered SERMs (n = 859, 2.44%), followed by those administered bisphosphonates (n = 4451, 3.00%), denosumab (n = 484, 3.19%), no medication (n = 19 017, 3.39%) and PTH (n = 873, 5.35%); however, the age-adjusted incidence was the lowest in patients administered denosumab (2.22%), followed by those administered bisphosphonates (2.35%), SERMs (2.39%), no medications (3.39%) and PTH (3.67%). The MPR was highest in patients administered denosumab (60.0%). Among patients without a second hip fracture, the rate of patients with MPR ≥80% was highest among those administered SERMs (40.8%), followed by those administered bisphosphonates (38.0%), denosumab (35.4%) and PTH (12.2%).

CONCLUSION

Differences in patient background characteristics and the rate of patients with MPR ≥80% might underlie the observed differences in the crude incidence of second hip fracture among the medication groups. Geriatr Gerontol Int 2022; ••: ••-••.

Second hip fracture in older adults: incidence and risk factors

PURPOSE

A second hip fracture can occur in older adults who have already suffered an initial hip fracture. The aim of this study was to determine the incidence, mortality and risk factors for second hip fractures in older adults with hip fractures.

METHODS

Between 2009 and 2019, 2013 patients (mean age: mean age 76.5 ± 5.4 SD) who were admitted to a tertiary care hospital for a hip fracture surgery were retrospectively analyzed. The patients were divided into two groups: those with a second hip fracture and those without a second hip fracture within the following two years after the initial fracture.

RESULTS

321 patients (15.9%, mean age: 85.3 ± 4.9 SD) sustained a second contralateral hip fracture, the first two years after the initial hip fracture whereas 136 patients (6.8%) sustained a contralateral hip fracture within 12 months. In total 274 (13.6%) died in the first two years after the initial hip fracture; among these, 139 patients (43.3%) had a contralateral second hip fracture. The mean time from the first hip fracture to second hip fracture was 13.2 ± 7.6 months. The advance age, female gender, living alone, dementia, chest and urinary tract infection, chronic heart failure, peripheral vascular disease were identified as risk factors for a second contralateral hip fracture.

CONCLUSIONS

Identifying risk factors for a second contralateral hip fracture can be particularly helpful in providing focused medical assistance.

Incidence of different types of subsequent fractures and related mortality in Taiwan

Hip fracture is the most common type of fracture to occur within 2 years after an initial fracture. Mortality risk increases when a subsequent fracture occurs. The occurrence of subsequent fracture is significantly higher in patients with hip fractures than others. Prevention of subsequent fracture is of paramount important.

PURPOSE

Osteoporotic fracture significantly increases risk of subsequent fracture. In this retrospective cohort study, we used the Taiwan National Health Insurance Database (NHIRD) to analyze data on fractures in a group at high risk of osteoporosis. We aimed to distinguish differences in subsequent fracture types and their relationship with mortality.

METHODS

We enrolled patients aged ≥ 50 years old who were diagnosed with an initial fracture classified as hip, vertebral, upper end of the humerus, or wrist. Data from 2 years of follow-up were analyzed. Risks of subsequent fracture events and mortality were calculated by Kaplan-Meier estimation and assessed with Cox proportional hazards models.

RESULTS

We included 375,836 patients from the 2011-2015 NHIRD. Patients with initial hip fracture had the highest incidence of subsequent fracture at both 1- and 2-year follow-up (7.0% and 10.9%). Subsequent fractures occurred mainly at the hip. Conversely, other patients had a higher proportion of subsequent vertebral fracture. Patients with subsequent fracture classified as hip, vertebral, and upper end of the humerus had significantly higher cumulative mortality rates than that of patients who had no subsequent fracture, with adjusted hazard ratios of 1.64 (95% CI = 1.57-1.71, p < 0.01), 1.06 (95% CI = 1.00-1.12, p = 0.04), 1.31 (95% CI = 1.17-1.46, p < 0.01), respectively.

CONCLUSION

Patients who experienced an initial hip fracture are at greatest risk of subsequent fracture, most commonly the hip. Occurrence of subsequent fractures was associated with an increased mortality risk. Thus, there is a need for early intervention following initial hip fractures.

Pilot study: To assess feasibility and tolerability of a minimal invasive implantable PEEK device for prevention of contralateral osteoporotic hip fracture

A non-comparative multi-centre and international pilot study have been carried on Y-STRUT® (Hyprevention, France), an implantable medical device meant to reinforce the hip to reduce the risk of a contralateral hip fracture. Objectives of the study were to determine the feasibility and tolerance of the procedure. Methods Patients older than 60 years were recruited when presenting at the emergency departments with a low-energy pertrochanteric fracture on one side and with a fracture risk assessed for the contralateral side with BMD, T-Score or other bone quality evaluation tool, FRAX index, or fall risk assessment. Pain and functional ability were assessed at the different follow-up visits using VAS, WOMAC and OHS-12 scores. Results Twelve patients were included and reached a one-year follow-up. Mean age was 82 years old (65 - 91). The average hospital stay was 13 days (3 - 29). The prophylactic surgery did not delay the hospital discharge for any patient. The procedure did not lead to unresolvable serious adverse events. At 3 weeks, all patients were able to walk 6 meters, half of them in less of 30 seconds. Minimal pain was reported all along the follow-up visits, except at 3 years when one patient presented high pain in both hips. WOMAC and OHS-12 scores showed a moderate to mild hip impairment. Conclusion The good short and medium-term outcomes of this pilot study demonstrate the feasibility and the tolerability of the device. Further studies should focus on the efficacy of this immediate and lasting bone reinforcement technique.

Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients

Background

Proximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors for consecutive PFF.

Methodology

Pilgrim Hospital PFF database from 2012 to 2019 was retrospectively analyzed. Patients over 60 years with low-energy fractures were included. Pathological and atypical fractures and polytrauma were excluded.

Results

There were 114 patients (4.18%) with contralateral hip fractures out of a total of 2727 PFF patients; 80% were females. The mean age was 82 years for the first hip fracture and 85 years for the second. The average time interval between fractures was 36 months. The fracture pattern was the same on both sides in 74.3% of patients (P<0.0001). Out of 53 patients with cemented hip hemiarthroplasty (CHH) on one side, 31 patients (59%) had a second CHH for the contralateral side. Likewise, out of 48 patients who had dynamic hip screw fixation during the first admission, 33 patients (69%) had the same procedure on the contralateral side too.

During the two consecutive admissions, the length of hospital stay was not significantly different (P=0.30), median American Society of Anesthesiologists (ASA) grades were 3, hyponatremia increased from 25% to 29% (P=0.5), mean decline in abbreviated mental test score (AMTS) was 0.4, deterioration of Clinical Frailty Score and Charlson morbidity index were from 4.5 to 5.9 (P<0.0001), and from 5.4 to 6.1, respectively, and institutional residency was increased from 23 to 46 (P>0.0014).

Conclusion

The similarity of fracture pattern bilaterally requiring similar surgical procedures is comparable with other literature. Even though there is minimal or no change in the ASA, AMTS, and hospital stay between the two admissions, there is a significant decline in clinical frailty, mobility status, and an increase in residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing secondary preventive measures to prevent a consecutive fracture.

Disease-dependent variations in the timing and causes of readmissions in Germany: A claims data analysis for six different conditions

BACKGROUND

Hospital readmissions place a major burden on patients and health care systems worldwide, but little is known about patterns and timing of readmissions in Germany.

METHODS

We used German health insurance claims (AOK, 2011-2016) of patients ≥ 65 years hospitalized for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack, or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, or osteoporosis to identify hospital readmissions within 30 or 90 days. Readmissions were classified into all-cause, specific, and non-specific and their characteristics were analyzed.

RESULTS

Within 30 and 90 days, about 14-22% and 27-41% index admissions were readmitted for any reason, respectively. HF and S/AF contributed most index cases, and HF and COPD accounted for most all-cause readmissions. Distributions and ratios of specific to non-specific readmissions were disease-specific with highest specific readmissions rates among COPD and AMI.

CONCLUSION

German claims are well-suited to investigate readmission causes if longer periods than 30 days are evaluated. Conditions closely related with the primary disease are the most frequent readmission causes, but multiple comorbidities among readmitted cases suggest that a multidisciplinary care approach should be implemented vigorously addressing comorbidities already during the index hospitalization.

Low psoas major muscle area as a risk factor for contralateral hip fracture following intertrochanteric fracture

OBJECTIVE

This study aimed to investigate the relationship between the psoas major muscle area as a risk factor and subsequent contralateral hip fractures in patients with initial intertrochanteric fractures.

METHODS

Of 136 treated for intertrochanteric fractures, 104 female patients had computed tomography done to assess their fractures at initial stage and had been followed up for more than 2 years. These patients were then divided into 2 groups: i.e. those who had a contralateral hip fracture (CF) (n=16) and those who did not (NF) (n=88) groups. We mainly assessed the relationship between the corrected psoas major muscle area (CPMA) at initial fracture and the occurrence of contralateral hip fracture.

RESULTS

The CF group had significantly lower CPMA than the NF group (p=0.001). There was positive correlation between the CPMA and the period from the initial to the contralateral hip fracture in the CF group. The CPMA cutoff value of 480.98 mm2/m2, was showed sensitivity of 63.6% and specificity of 87.5% in receiver operating characteristic curve analysis for all patients.

CONCLUSIONS

The lower CPMA was associated with the contralateral hip fracture within 2 years from initial intertrochanteric fracture. The low CPMA would be a risk factor for contralateral hip fracture.

Incidence of Non-Simultaneous Contralateral Second Hip Fractures: A Single-Center Irish Study

Introduction

Hip fractures are a significant cause of morbidity and mortality in the elderly and are also associated with increased healthcare costs. A second contralateral hip fracture can lead to even more complications and healthcare costs. A significant proportion of the Irish hip fracture population does not receive a bone health assessment or falls specialist assessment to reduce the risk of future falls and fractures. This study aimed to analyze the incidence of a non-simultaneous contralateral hip fracture in an Irish population.

Methods

We retrospectively analyzed 1,344 patients presenting to our institution with a hip fracture from January 2007 to June 2019. Patients aged ≥ 60 years old presenting with a neck of femur or pertrochanteric fracture were included in our study. We excluded patients who had sub-trochanteric and femoral shaft fractures, high energy fractures, and pathological fractures. We also excluded patients less than 60 years old, as fractures in these younger patients may not be purely related to osteoporosis.

Results

A total of 1,099 hip fractures meeting the inclusion criteria were treated at our unit during the designated time period. A total of 102 (9.3%) patients experienced a second hip fracture. The mean age at first presentation in our institution was 78.5 years old, with a mean time between first and second hip fractures of 37.2 months.

Conclusions

Patients presenting with a second hip fracture may represent 9.3% of the Irish hip fracture population. We hope that this study will help inform on the rate of second hip fractures in an Irish population and help advocate for improved resources and implementation of secondary prevention strategies.

Risk factors for subsequent hip fractures and fatality after an initial hip fracture in Korea: using nationwide claims data

In this study, the risk of fatality after hip fracture but not the risk of subsequent hip fractures was higher among men.

INTRODUCTION

The purpose of this study was to analyze the risk factors for subsequent hip fractures and fatality after an initial hip fracture among Koreans older than 50 years of age using information in the national claims database.

METHODS

Our study was conducted using data from the Korean National Health Insurance Service database from 2007 to 2016. A total of 16,915 Korean patients aged ≥ 50 years with a first hip fracture in 2012 were followed for 4 years. Data on fracture, comorbidity, and prescription variables were retrieved from the national registry. The Cox proportional hazards model was used to identify the risk factors affecting subsequent hip fractures and fatality after the initial hip fracture.

RESULTS

A total of 952 patients had subsequent hip fractures, and 6793 patients died. The cumulative incidence rates were 1.3% after 1 year and 5.6% after 4 years. Old age, renal disease, dementia, and Parkinson's disease were associated with a higher risk of subsequent hip fractures. The fatality rate after the initial hip fracture was 1.6 times higher among men than among women. Certain risk factors for fatality, such as pneumonia after fracture, cerebrovascular disease, mild liver disease, renal disease, and malignancy, were more prevalent among men.

CONCLUSION

During the study period, the risk of fatality after hip fracture but not the risk of subsequent hip fractures was higher among men. The gender difference in fatality might be explained by the larger burden of comorbid diseases among men.

The impact of second hip fracture on rehospitalization and mortality in older adults

PURPOSE

Although a second hip fracture is not uncommon in the older population, the extent to which such an event may affect health-related outcomes has not been fully clarified. We aimed to evaluate the risk of new falls, functional decline, rehospitalization, institutionalization and mortality in older patients admitted for a second vs. a first hip fracture.

METHODS

The sample consisted of 288 older patients admitted to the Orthogeriatric Unit of Bolzano Hospital (northern Italy) and surgically treated for a hip fracture from June 2016 to June 2017. Socio-demographic data and hospitalization-related information were collected and a multidimensional assessment was made upon admission and during the hospital stay. Fifteen months after discharge, data on mobility level, functional status, institutionalization, and new falls were obtained from personal or structured phone interviews. Information on rehospitalization and mortality was obtained from local hospital registers.

RESULTS

One out of six patients (14.6 %) admitted was suffering a second hip fracture, of which only 16.7 % were on antiresorptive therapies. At the 15-month follow-up, individuals who had been treated for a second hip fracture were more likely than those treated for their first to have low mobility levels (OR = 4.13, 95 %CI:1.23-13.84), to be rehospitalized (OR = 2.57, 95 %CI:1.12-5.90), and to have a higher mortality (HR = 1.81, 95 %CI:1.05-3.12).

CONCLUSIONS

The occurrence of a second hip fracture may further affect the clinical vulnerability and mortality of older adults. These results highlight the need to implement preventive action to minimize the risk of re-fracture after the first event.

Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients

Summary.

BACKGROUND AND AIM OF THE WORK

Given the high impact of proximal femur fractures (PFFs) on elderly patients and healthcare systems, the burden of contralateral PFFs might be overlooked. Aim of the study is to analyze the epidemiology and risk factors of contralateral proximal femur fractures. Secondary aim is to detect mortality rate differences in first and contralateral PPF.

METHODS

A population of 1022 patients admitted for proximal femur fractures in a single center was studied. Prevalence at admission as well as incidence of contralateral PFF during a 18 to 36 months follow-up was recorded. Epidemiology of contralateral PFF was studied recording number of events, time to second fracture and fracture type. Mortality at 1-year was recorded for all patients and compared between first and second PFF patients. Comorbidities, pharmacotherapy, BMI, MNA and SPMSQ were studied as possible risk factors.

RESULTS

Prevalence and incidence of contralateral PFFs were 9.4% and 6.5% respectively. Median time to second fracture was 12 months. One-year mortality of contralateral PFFs was significantly lower (20.5% vs 25.1%, p 0.003) than first PFF. Contralateral fracture patients had a significantly lower BMI and a significantly lower proportion of malnourished patients.

CONCLUSIONS

The incidence and prevalence of contralateral PFFs is relevant. Mortality of contralateral PFFs results to be lower than first PFF. Patients with higher BMI and malnourished patients have a lower risk of contralateral PFF.